TKR Quads and ROM

[Bfan]

Week 5 was very tough. Could not seem to get on top of pain control. So many pills Advil, Tylenol, Tramadol.. and I try to take as few as possible. Is there a reason that pain seems to be particularly bad 4am until I get up in the morning? Seemed like I really took two steps back this week.. particularly the days after PT. Very tough surgery. I've been an athlete my whole life so I know how to play through it... but this is on a different level. Positive thoughts to all of us going through it. Do not see the end of the tunnel but hanging in there.

 

[benne68]

Seemed like I really took two steps back this week.. particularly the days after PT.

That's your knee telling you that it wasn't ready for something (or things) you did in PT. Listen to your knee -- it is still healing from the trauma of surgery.

Could not seem to get on top of pain control. So many pills Advil, Tylenol, Tramadol.. and I try to take as few as possible.

It's much too soon in this journey to be trying to cut back on pain relief! Take your pills on a regular schedule as prescribed by your surgical team. Don't skip doses or you will end up chasing the pain and never catching up. You should also ice and elevate as much as possible.

You might want to re-read these two articles about pain management.
The importance of managing pain after a TKR and the pain chart
Ice to control pain and swelling

​

 

[Jockette]

Could not seem to get on top of pain control.

particularly the days after PT.

BoneSmart philosophy for sensible post op therapy

You will have noticed there is a significant opinion here about the potential hazards of PT. You may feel that your therapists are experts and know what you should be doing. However, over the last several years I've been here, I have observed that the more intensive the regimen of exercising...

bonesmart.org

Check out this article from the Bonesmart Recovery Guidelines. You might want to consider making some changes to what you do, and allow, at PT, and any home exercises.

 

[MSuki]

Every time your therapist pushes you too hard I think they are injuring soft tissue. Hard to heal something that is constantly reinjured. You might call in sick to a session and focus on ice and rest, while taking your medication, and see if you feel a lot better.

 

[Bfan]

Calling in sick this Tuesday is a good idea. Try too hard to be the good team-
mate/student.

 

[Jockette]

Try too hard to be the good team-
mate/student.

Check out this article from the Bonesmart Library:

Lose the Work Ethic While You Are Recovering!

Lose the Work Ethic!!! Article by Referee54 (Tim) Many of us have a tremendous work ethic---and for several reasons. I can still remember, to this day, my father saying to me on the morning of my first day on a “real job”, “Give them nine hours of work in an eight hour day.” I believe that...

bonesmart.org

 

[Bfan]

I've been a writer for 35 years and this is a compelling piece of writing. Thank you for sharing. It sure is hard to get past the work hard, no pain no gain ethos. I do know the beating the **** out of myself sure isn't working. It's just sending me into a mental spiral. A dark cloud follows me on the drive over to PT because I know they'll be pushing me knee to get to a number I just can't do. I've been more firm with them but I can tell there's an attitude of.. Fine, don't get better.

 

[Jockette]

A dark cloud follows me on the drive over to PT because I know they'll be pushing me knee to get to a number I just can't do. I've been more firm with them but I can tell there's an attitude of.. Fine, don't get better.

Yes, some PTs can make us feel that way, and that does not enhance our healing. We need to be bold and take charge. It’s our recovery, not theirs.

Maybe you could consider looking for another PT office, one that is less aggressive and more encouraging. Call around and interview some and see what they say. Not all PTs are created equal.

 

[Layla]

Very tough surgery.

Yes!
Your leg endured major trauma, in a very small area, albeit controlled. Your muscles, tendons, ligaments and other soft tissue is going to cause you discomfort and pain for a while yet. Take the meds on schedule for as long as you need to in an effort to remain comfortably mobile and able to rest easy.

Please do not allow the physical therapists to push you in your sessions and try not to be intimidated by any type of negative attitude they give you. PT’s come a dime a dozen, so If they're making you feel “less than”, give some serious consideration to moving on. Lots of comfort to you! Thanks for joining us and congrats on your new knee.

 

[MSuki]

I completely understand the difficulty of holding firm. I had this problem on the steps. My PT who is normally great and would never bend my knee forcibly, was certain that I should be able to do step ups on land. And I should have been able to, but I couldn’t. Her response would be things like “well can you just do 5?“ or “how about this shorter step?” etc. And 3 days later at the next session we would be back on it. Every time this came up it made me feel a little like a failure and it was exhausting to argue about it.

And this is a PT who I have known for years and really respect. The hardest part in pushing back is that I 100% know she’s trying to help me and has my best interests at heart. But she can’t feel my knee and my leg.

 

[sistersinhim]

But she can’t feel my knee and my leg.

This is exactly why we say to always be in control of what your leg is doing. What works for one might not work for another.

 

[kayakker]

Very tough surgery. I've been an athlete my whole life so I know how to play through it... but this is on a different level.

Very tough, for sure! I had mine 12.18.23 and am, today, 8 weeks out. I was running 4 miles easily in April and, by September, I could barely walk a block. I had both hips replaced (ages:50 and 54) and there is absolutely no comparison. I walked a mile my first week after THR. Friday, I walked a mile and paid for it all weekend. Hang in there. I found week 7 brought notable improvement.

 

[Bfan]

A friend who had TKR loaned my her Normatec compression pants. She said it helped. Has anyone else used these? Are they safe? I'm so desperate to loosen my knee I'll try anything. Saw my surgeon for 6 week check in. I told him I'm only at 115 degrees of ROM with gentle forcing. He said he's hoping that gets better or I might be a candidate for MUA. From what I read here that sounds aggressive. I'm not jumping into that so quickly. I'm assuming it hurts like hell after and puts you back to square one on PT. Is that the case? I'm feeling no matter how much I stay on track someone always swoops in to scare me about ROM. I want better ROM too, but my knee says, that's as far as I'm going. My knee does get swollen and I have trouble sleeping but I think I'm getting around pretty good. This has been a painful and frustrating experience.

 

[WFD]

@Bfan , 115 degrees at what, 5 weeks? That’s amazing. Anyone who says you need an MUA must be smoking crack.

You are basically already there. Relax, let things heal, and you’ll gain more ROM and be done.

You want easy motion to clear the swelling from your knee and assist in blood flow so your leg can continue to heal, but you do not need to undergo any painful exercises or manipulations because you are already there.

Color me jealous…

 

[selketine]

I told him I'm only at 115 degrees of ROM with gentle forcing. He said he's hoping that gets better or I might be a candidate for MUA.

Well if that's true I'll be in there with you because I'm at 5 weeks and she measured my ROM last week at 90.

What's odd is that...the home PT measured me at 89 at 2 weeks and the physician's assistant said I was at 90. I can bend my knee WAY farther now than at 2 weeks so...surely it got better. I'd be thrilled if someone said I was at 115 - haha! It's very frustrating to be saddled with that number because I thought I was doing pretty good.

I also have had swelling and not able to do do as many exercises after having PT - just feels like it takes me backwards for 2-3 days. She isn't aggressive but it's too much all at once I guess as I usually spread exercises out all day long. I also can't walk without the walker. I had been able to try the cane in the house over the weekend but after PT yesterday I can't do it.

I can't imagine why the doctor would mention a MUA if you're at 115 at 6 weeks - seems great to me!

 

[Jockette]

I'm so desperate to loosen my knee I'll try anything.

Your knee is going to feel tight for quite a while yet. You’ve had major surgery that caused a lot of trauma inside your knee/leg. You don’t heal from that in 4 weeks. Complete healing takes an average of a year.

I told him I'm only at 115 degrees of ROM with gentle forcing. He said he's hoping that gets better or I might be a candidate for MUA.

Your ROM is fabulous for only 4 weeks post op. I don’t understand why this doctor would tell you this.

I want better ROM too, but my knee says, that's as far as I'm going.

Right now your knee is the Boss. Respect it and give it the privilege of sorting itself out. It will, in time.

My knee does get swollen and I have trouble sleeping but I think I'm getting around pretty good.

This is excellent. Your opinion is the one that matters the most.

 

[Bfan]

Many thanks to all of you who remind us and give solid advice.

 

[Bfan]

Has anyone used compression pants like Normatech to bring down swelling. Are they safe? A friend has offered to loan them but I wanted to see if anyone had experience with them. Thank you.

 

[Jockette]

I just did a quick search on Bonesmart and here are some mentions of compression pants:

Search results for query: Compression pants

bonesmart.org

When I was in the first year of recovery didn’t want anything remotely tight on my surgical leg, so I would not have been interested in something like this.

My PT did tell me I could have swelling for a year, and it did vary quite a bit my first year.

I‘m sure you don’t want to hear this but try to relax about your swelling, your ROM, and anything else about your knee/leg right now. It is what at it is and things will improve in time. You are having a very normal recovery and don’t let anyone tell you that you’re not. I forget how @Roy Gardiner stated it, but he basically said, relax, watch telly (he’s from the UK) and let your body heal. He had both knees done the same day, and had a great recovery. But it took time.

 

[Bfan]

I guess my nature is to push myself. I hear you and appreciate what you're saying. You're right. I have to remind myself every day that this is a long journey.